Neurosurgery Coding Alert

Question: Our neurosurgeon and an otolaryngologist performed co-surgery for a case described as "resection of the midline skull base extradural tumor extension, endoscopy." Then used a trasnssphenoidal endoscopic approach to the lesion. They resected the lesion, extending the posterior wall of the sphenoid sinus through that space, then abutting the dura. How should we code this case?

Alabama Subscriber

Answer: If the tumor was a pituitary neoplasm, the most accurate CPT code is 62165 (Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or transsphenoidal approach). If the surgeon resected a non-pituitary extradural neoplasm, submit 64999 (Unlisted procedure, nervous system) instead. For either scenario, append modifier 62 (Two surgeons)since multiple surgeons participated in the case.

Comparison: You could report similar procedures with 61607 (Resection or excision of neoplastic, vascular, or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; extradural). 61607, however, describes the definitive skull base procedure of resecting a midline extradural skull base tumor and represents an open procedure rather than endoscopy. Because you're coding an endoscopic approach, 62165 or 64999 are more accurate choices.